The most important objectives of the long-term project are: (1) to articulate and evaluate the comparative effectiveness of the two most promising modern therapeutic programs--milieu therapy (based upon therapeutic community) and learning therapy (based upon token economy)--for returning the "hard core" chronic mental patient to the community--effectiveness in relation to each other, and to traditional hospital treatment, when all include systematic after-care services; (2) to identify limits of change which can be accomplished with the overall programs within the staffing restrictions of state mental hospitals; (3) to explore systematic effects of both programs with regard to differential areas of success; (4) to explore the prognostic value of patient characteristics and functioning as criteria for release and community stay, as well as post-release environmental factors; (5) to demonstrate a feasible model for investigating institutional treatment programs under "real life" conditions, providing more rigorous design, controls, and procedures than previously attainable. Three groups (84 beds total) are involved in the study--two units established at the Meyer Zone Center (MZC) to house the experimental programs, and one group at a large state hospital (KSH). Study patients are selected from those chronic mental patients not accepted for shelter-care placement, equating groups at pretreatment on 16 variables, with equation maintained when replacements occur. Intramural operation on a closed-research basis, with the same staff conducting both experimental programs, is planned for three years with 6 monthly assessments of patients in all groups, and continuous assessment of patients and staff on experimental units. During the latter period, specific criteria for release to productive and relatively independent functioning (not shelter-care) are maintained, with intensive after-care on a declining contact schedule for 26 weeks. Six-monthly follow-ups are planned for two years. As soon as "hard data" are available for decision making (end of 3 years intramural and/or end of two year follow-up analyses), experimental units will function as a service-demonstration-training center for mental health staff to gradually introduce procedures found effective throughout the center, and to other hospitals and mental health centers.